Thursday, 16 March 2017

There
is a common misconception that there is a pill to fix virtually any health
issue. I've written about this before ('A pill for everything?') in relation to
medications for dementia (most notably prescribed for people with Alzheimer's
Disease), but for this blog post I want to concentrate on a topic I'm seeing
with alarming frequency in my consultancy work - Poly pharmacy.What
is poly pharmacy?Poly pharmacy is when a person, often an older
person, is taking 4 or more medications. It's often related to older people
because as our bodies age, more can start to go wrong that requires medication (or that it's perceived requires medication). Poly pharmacy is also
more dangerous as we age because our bodies often can't cope with multiple
medications as well, putting strain on vital organs and potentially affecting
the person both physically and mentally.How
does poly pharmacy happen?Very
easily! Common medications that occur frequently in cases of poly pharmacy
include drugs to treat high blood pressure, digestive problems, pain, diabetes,
thyroid problems, sleeping problems, and medications for
depression/mood/behaviour. Indeed, many times in my dad’s life with vascular
dementia he was prescribed more than 4 medications, making him the subject of
poly pharmacy (although we had never heard of this at the time).There
is a well worn joke that as you age you 'rattle' from all the pills you swallow,
but poly pharmacy is no laughing matter, nor should it be ignored or considered
'the norm'.Why
is poly pharmacy a problem?

Once a person is taking more than 4
different medications, pharmaceutical companies cannot reliably tell you what
the side-effects might be. Of course there might be none, but there could also
be serious underlying problems developing that the person either is or isn't
aware of. Unchecked, at best these can impact on the person's quality of life,
and at worse could lead to serious illness or injury (for example falls if the person experiences sleepiness as a side-effect).How
does poly pharmacy impact upon a person with dementia?

Many
people with dementia also live with other long-term conditions that require
medication, or they are given medication to prevent certain conditions from
developing (for example a statin because it's believed they lower cholesterol, although opinions are divided). Given the nature of the cognitive
problems that characterise dementia, the person may be more vulnerable to being
given medication because unlike someone who isn’t living with dementia, a
person with dementia may not have the communication ability, or confidence, to question a
prescription effectively.

The
tipping point

The
tipping point into poly pharmacy will vary from person to person, entirely dependent
upon whether the individual has historically been a person who has lived with
multiple long-term conditions for a long time prior to their dementia and is
used to managing some or all of those conditions with medications.

However,
the prescription of anti-dementia medication upon a diagnosis of dementia might
take a person into the realms of poly pharmacy, as might the prescription of
sleeping medication or anti-depressants, both of which are common
pharmacological ways of 'managing' problems a person with dementia is perceived
to have with 'behaviour'.

Questioning
the prescription of such medication to manage 'Challenging behaviour' (a phrase I dislike - read this blog for the reasons why) is particularly
important because these medications are often used instead of the more
controversial antipsychotics. Antipsychotics have been the subject of a
target to reduce their prescriptions since they were linked with serious side
effects and even the premature deaths of people with dementia.

Replacing
one 'chemical cosh' with another one, albeit potentially a milder type
of medication, is still dangerous in my opinion, especially in a person already
taking other medications who is then at risk of poly pharmacy.

Standing
up against poly pharmacy

I
feel strongly that everyone needs to understand the risks of poly pharmacy.
That's not to say that every medication given is wrong, or that anyone should suddenly
stop taking medications that may be absolutely essential to them. But awareness
of poly pharmacy, the confidence to try and guard against becoming the subject
of poly pharmacy, and regular reviews for anyone taking multiple medications is
absolutely vital.

Doctors
who understand poly pharmacy would always be very supportive of trying to avoid
it, and only prescribing absolutely essential medications that are then
regularly reviewed.

Supporting
a person with dementia who may be at risk of poly pharmacy

Ideally,
a person with dementia would be supported at medical appointments by a family
member, friend or advocate, but that won't be the case for everyone. If the
person is alone, or the individual with them doesn’t feel confident in speaking
up or questioning a medication, then often the medication will just be
prescribed.

Even
social care professionals accompanying a person from a care home to a GP or
hospital appointment may not feel they have the skills to question a prescription. For this reason, it is vital that training in poly pharmacy and
empowering staff confidence is given by all social care providers, as they are
often unofficial advocates for a person with dementia.

About Me

I'm a campaigner and consultant, writer and blogger. My dad had vascular dementia for approximately the last 19 years of his life. I aim to provide support and advice to those faced with similar situations, inform and educate care professionals and the wider population, promote debate and create improvements in dementia care.